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Coping with loss and stress during pregnancy

Keeping going when your world is falling apart is always tough, but doing so when pregnant can seem overwhelming

Coping with bereavement, the breakdown of a relationship, losing your job, domestic violence or anxiety about a loved one can be hard enough at the best of times. When you are pregnant and feeling particularly vulnerable, it can be even more difficult to cope with trauma or stress. A great deal of your emotional energy is already being expended on the important job of nurturing your baby, as well as adjusting to a new set of responsibilities. And in the storm of pregnancy hormones, you may already be experiencing mood swings or new and unfamiliar emotions. These factors, combined with anxiety about the effect of stress on your unborn baby, could leave you feeling overwhelmed and unable to cope with additional strain. It’s important to realise however, that you are not alone, and that what you’re feeling is perfectly normal.

What’s more, there’s probably more help and guidance available to you than you realise – so you should make sure that you get as much support as you need. And the great think about being pregnant is that no matter how much bad stuff is going on in your life, there’s the promise of something wonderful just around the corner. A new baby is an assertion of life and hope, capable of bringing happiness at even the saddest of times. You will probably find that it is the bundle of joy growing in your tummy who will give you a reason and the strength to get through it all.

What are you feeling?

“The first thing to say is that everyone is different and we all deal with stressful situations in different ways,” says Pat Ingham, a midwife counsellor at the Rosie Hospital, Cambridge University Hospital’s NHS Foundation Trust. “There is no ‘right’ way to feel in any given situation.” According to Pat, the reaction of ‘I can’t deal with this while I’m pregnant’ is very common. “Your brain may filter bad news into more manageable amounts in order to, as it were, postpone dealing with some of it until after the baby is born.”

Equally, you may be surprised at the intensity of your reaction. Claire Odeon Hershaman, counsellor and psychotherapist explains: “You tend to feel very vulnerable when you are pregnant. You are full of strange new hormones, and as a result you may experience emotions you never knew you could feel.” Claire goes on to say, “The most important thing is to take yourself seriously. You are thinking and feeling for two, and so it is perfectly normal to find that you are not coping quite as you usually would in a certain situation.”

What does the baby experience?

Maternal emotions trigger the release of chemicals into the mother’s bloodstream, which pass through the placenta to the baby. Anger releases adrenaline, fear releases cholamines and joy releases endorphins. “We don’t, however, know how the baby would interpret those emotions,” says Gail Johnson of the Royal College of Midwives. “It may receive the same chemicals as the mother, but there is no research to suggest it experiences them in the same way.” A sudden rush of adrenaline caused my maternal anxiety might cause a dormant baby to wake up and suddenly become more active, “But that is a perfectly normal reaction,” says Gail. “It does not necessarily mean that the baby is feeling the same intense feelings of grief, anxiety or anger that he mother is experiencing.”

Is it a threat to the baby’s health?

“The effect of maternal stress is not known,” says Gail. “However, once could take the view that a degree of maternal stress could prepare a healthy foetus to cope with some of the challenges of later life.”

If the physical effects of stress become detrimental to the mother’s health, however – making her sleepless, depressed, causing lack of appetite, headache or backache, for example – the baby’s health could begin to suffer if these symptoms remain unaddressed. Inadequate nutrition or sleep can hamper our ability to handle stress, and can even exacerbate feelings of anxiety and tension. During stressful periods it is even more vital that you take good care of your physical wellbeing – ensuring you get enough rest, eat healthily, and allow yourself opportunities for relaxation. This way, you will make it easier for your body to deal with the additional emotional strain, while getting on with the important job of nurturing your baby.

Will a big shock bring on labour?

In the world of soap opera, shock or distress invariably sends any pregnant woman in the vicinity into premature labour – but don’t believe everything you see on TV.

“The evidence for sudden emotional trauma leading to miscarriage is quite weak,” says Gail Johnson. “In reality, when a woman becomes over-anxious, her body tends not to labour well. The body’s focus in stressful situations is on keeping the baby safe, and such circumstances are not conductive to labour commencing.” However, if you have any concerns about your baby’s wellbeing, notice any unusual changes in foetal movement or experience any symptoms which cause you concern, seek advice from your doctor or midwife.

What can you do to help yourself through difficult episodes?

“Where possible, it’s best to take yourself away from the source of the stress,” says Gail. “Put yourself in safe situations and disassociate yourself from as many potential causes of anxiety as you can. You don’t have to cope with this on your own, and you should not feel you have to do everything yourself.” Gail suggests you seek appropriate support from family and friends and book an appointment to talk to your midwife or GP to find out what help is available to you.

Clare Odeon Hershman says: “The most important thing is to recognise what’s going on and, if things are not as they should be, to find a source of help that you feel comfortable with.” She adds, “You are carrying a future life so you need to look after yourself and your baby as responsibly as you can.”

What help is available?

Of all the NHS GP surgeries in England, 73.6% now have access to a counsellor to whom they can refer patients. The figure for Wales is 63%. Many maternity units now also employ special midwife counsellors: midwives with counselling and psychotherapy training who can offer short-term, one-to-one counselling free of charge. In both cases, every effort would be made to ensure that a pregnant woman was seen quickly.

“This might be the first time you have thought about counselling,” says Claire, “but seeking help of this kind doesn’t mean you’re barking mad!” She continues, “Being pregnant is very special: you are doing a difficult and important job, so may not be able to deal with emotional stuff as effectively as you might normally. A counsellor’s job is to help people manage such stuff. You may need just a bit of time and space to explore what you are feeling and get some clarity in order to deal with everything that is going on.” There are also many specialist support groups – enquire at your local surgery about ones that are running in your area.

Treating depression

Between 10% and 16% of pregnant women suffer from a degree of antenatal depression, which can be brought on or exacerbated by emotional trauma or stress suffered through pregnancy. Seeking appropriate treatment is very important, as depression can stop you from taking optimum care of yourself and your baby during pregnancy or in the early months of the baby’s life.

Certain anti-depressant medication can be safely prescribed during pregnancy, and deciding whether this is the right course of action for you will involve discussion with your doctor or obstetrician, to weigh any possible risks against the potential benefits. “If your GP is reluctant to prescribe anti-depressants, you may want to speak to your obstetrician who has expert knowledge in this field,” says midwife counsellor Pat Ingham. “Some maternity units now also offer the provision of perinatal psychiatric clinic, to which you may be referred if necessary. With so much help on offer, you really don’t have to suffer in silence.”

Mum’s story

Nicola Smith, a consultant from London, is 38 weeks pregnant. Early in her pregnancy, her father broke his back in an accident.

“I remember feeling intense panic and fear, and I couldn’t stop crying and shaking. We had been planning to keep the pregnancy a secret until after the 12-week scan, but outside the X ray room there were signs advising pregnant women to inform the operatives. This made me really worried so I told my mum, who promptly burst into tears. Telling dad was slightly surreal. He was lying twisted in agony and we were all terrified, not knowing the prognosis, but he was thrilled about the baby, despite the bouts of pain.

I felt a real conflict between anxiety about the baby and a sense of selfishness. I was caring for someone even more precious than my parents, someone who was also a part of my husband – it felt like a higher responsibility. James was away at the time and had to try and get back, but he didn’t want me to get run down and hurt the baby in some way.

The accident rushed us into telling people about the baby earlier than we’d planned: it wasn’t the celebration we’d hoped for. My mother-in-law rang to congratulate me but all I could do was cry about Dad – I couldn’t tackle the two events at the same time.

Dad was really lucky. He avoided paralysis and, with great strength of character and support from Mum, has made a full recovery. I think that focusing on the baby has helped him get through all the pain and frustration. We are so fortunate to have had a baby on the way and a healthy grandpa to love her.”